| NPI | 1437738515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MA RBT-21-159057) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2021-10-15 |